Working as a Nurse Practitioner: Clinical Diversity

clinical diversity

When someone asks me what it’s like to work as a Nurse Practitioner (NP), be it a nurse, student, or layperson, I often reply, “Well, it depends.”  I answer this way because the different positions I have had as a Family Nurse Practitioner have all been very different and different yet from my colleagues and friends.  This is one of the great things about the opportunities of advanced nursing practice – clinical diversity.  

Depending on an NP’s interest and preferences, a career as an NP can offer many different opportunities.  From pediatrics to geriatrics, inpatient or outpatient, scheduled appointments versus walk-in clinics, acute illness versus chronic disease, primary care or specialty care, and then considering the multiple combinations of these factors – the options are numerous.  The opportunity for such a range of places and populations was the real reason I focused on being a Family Nurse Practitioner in the first place.  I can give you some examples from my career, my recent job search for my latest position, as well as some insight into jobs my close NP friends have.

Military RN

For my first job out of graduate school, I worked in essentially what was the health department on a military post.  It was a very ethnically diverse population and consisted of mainly healthy young adults with curable infectious diseases.  I had some days that were reserved for the clinic with 15-minute appointments, some days that were open for walk-ins, and other days that I focused on education, such as smoking cessation and healthy pregnancies, and other prevention education.  I also served as a case manager for some patients that had chronic infectious diseases and coordinated their care with an infectious disease specialist in another state.  So, I had a lot of variability in this one position.

University Clinic

My second NP job was working in a university’s student health clinic.  Again, I was mostly taking care of a young healthy population with acute illnesses, such as respiratory infections, gastroenteritis, and musculoskeletal injuries.  There were some students who had chronic illnesses, such as asthma, that required some maintenance and follow-up.  I also performed some health promotion and wellness visits.  I had a set schedule with 20-minute appointments (or 40–minutes for well visits) and was able to order labs and x-rays in-house that were often ready within 15 or 20 minutes.  The clinic visit cost was covered by tuition, but labs, x-rays, and medications were paid for out of pocket, so I needed to be very cost-effective and cost-conscious.  I discussed treatment options with the students and worked with them in developing the treatment plan.  I worked with many physicians and was able to consult with them as necessary.  In this role, I focused a lot on education, helping the students understand what they needed to do to manage their own health independently without their parents.

The Interviewing Trail

Recently, I have been looking for a new job as the result of moving out of state.  Some of the jobs I interviewed for offered various unique opportunities.  

Surgery

One position would have given me an opportunity to work closely with a surgeon.  When the physician was busy in surgery or the clinic, I would start the initial consultation in the emergency room, performing the history and physical, acquiring necessary labs and diagnostic tests, and working the patient up in preparation for the physician’s consultation.  I would follow the patients into surgery, assisting with the procedures, and monitoring their recovery in post-op and in the hospital.  I would also have the opportunity to follow-up with patients in clinic.  This position would have given me a completely different job opportunity than my previous positions, but ultimately, probably would have been a better fit for a physician assistant (PA) or an acute care NP.

Continuous Observation Unit

Another job that I interviewed for was on a continuous observation unit.  When patients come to the emergency department for care but don’t meet requirements for hospital admission, they are sent to this short stay unit.  The unit is staffed 24 hours a day by NPs and PAs, who continue the plan of care initiated by the emergency physicians.  For example, if a patient presented with chest pain and normal EKG, the observation unit would continue to monitor the patient on telemetry and await cardiac enzyme lab results.  Being a short stay unit, it was very fast paced and there was high patient turn over.  The NPs and PAs were required to be flexible not only in the types of patients that were seen but also with the flow of patient care.  They also need to be great multi-taskers.  I thought this job would have been exciting, but unfortunately it was only part-time.

Nursing Home

The new job that I recently accepted is very different from all of these that I have described.  I will be providing acute care within a nursing home that has long-term care residents, rehab patients, and hospice patients.  The goal of my position is to address problems – acute illnesses, exacerbations of chronic disease, infections, or injuries – to prevent the patients from needing hospitalization. I will be working with a mainly elderly population, many of whom are frail, but also patients who need some rehab after surgery or longer hospitalization stays.  My schedule will be very flexible, and I will not have any scheduled appointments.  Some days may be lighter, while other days will be much busier, like when the flu hits the residents.  The nurses will let me know when patients are having problems or concern, and I will visit them in their private rooms to address their needs.  I will work closely with a geriatrician and have the ability to order labs and x-rays.  I will be able to follow-up with patients and monitor their health status as needed.  I will assist the physician with new admissions by performing a history and physical to ensure the patient is stable.  I will also perform discharge planning and make necessary arrangements for patients who are going home.  I will also provide comfort care for hospice patients and comfort grieving relatives.

Other Opportunities

A few more examples from colleagues will further emphasize the diversity of clinical opportunities.  An NP I know from graduate school works in pediatric neurology in a large university health system, seeing patients in clinic, mostly for follow-up after the physicians have initiated their plan.  Another friend of mine works in an inner-city school-based health clinic with low-income children and families.  I know another NP who works independently in a very rural clinic with uninsured patients without access to labs or other diagnostic tests.  She provides comprehensive care because there is no other access to health care for many miles and needs to rely on advanced physical assessment techniques to help in the diagnosis.

The limitless opportunities available to NPs are vast and diverse.  Depending on your interest in the types of patients you want to work with, the type of setting you want to work in, the area of the country where you want to live, the types of conditions you want to treat – there is the perfect job for every NP.  And opportunities are only continuing to grow.